Agenda and minutes

To receive any apologies for absence.

Apologies for absence were received from Keith Sangster, Co-opted Member.

In accordance with the Code of Conduct, Committee Members are requested to declare any interest in relation to items on the agenda.

Co-opted Member Margaret Dangoor declared a personal interest in items relating to Adult Social Care by virtue of her role as a carer.

Martyn Kingsford declared a personal interest in items relating to social housing, by virtue of his chairing the Investment Committee of Paragon Community Housing Group.

To consider the minutes of the meeting held on 19 June 2012 (attached).

The minutes of the meeting held on 19 June 2012 were approved as a correct record of proceedings and the Chairman authorised to sign them, subject to the clarification that the Co-opted Members’ presence was included:

Co-opted Members: Maureen Chatterley, Margaret Dangoor, Martyn Kingsford and Keith Sangster

To receive a verbal update from NHS North West London and West Middlesex Hospital NHS Trust on the ‘Shaping a Healthier Future’ consultation which closes in October 2012.

A presentation was delivered by Dr Mike Anderson (Medical Director at Chelsea and Westminster Hospital and representing the ‘Shaping a Healthier Future’ programme board) and Anne Gibbs (Deputy Chief Executive and Director of Strategy at West Middlesex University Hospital). The Committee was informed about the current structure of hospitals in North West London and the challenges faced by NHS North West London. These challenges included those of population change, new clinical advances, fixed resources and financial constraints. It was further explained that:

(i)      Whilst investment in health services had occurred in recent years, this had been used to meet growing demands and a lower level of funding would require the NHS to use existing funds more intelligently.

(ii)    The re-alignment plans included the provision of a more integrated care service and the improvement of out of hospital care. Some services such as ‘major trauma’ had already been centralised and the reconfiguration would be based on this model. Specialist hospitals would not be affected by the proposals. It was envisaged that the North West London area needed to retain five ‘major hospitals’ and that other hospitals would become local hospitals.

(iii)   Whilst some Accident and Emergency (A&E) services would be closed, local hospitals would provide a 24 hour urgent care service which was more appropriate for many of the people who currently visited A&E.

(iv)  As part of the work to examine which hospitals should retain A&E services a study had been undertaken by the London Ambulance service looking at projected travel times. Other factors taken into account included where associated services such as neurosurgery were located, and the estate / physical capacity of each hospital.

(v)    Three Options had been set out for the reconfiguration of hospitals, which represented varying degrees of value for money, and would be consulted on formally. At present a pre-consultation stakeholder engagement process was taking place. Proposed changes were due to be implemented by 2016.

(vi)  It was considered that it was more important for patients to get to the right specialist hospital rather than the nearest hospital.

In response to questions the Committee was informed that:

(i)      It was felt that it would be more appropriate to locate a Hyper Acute Stroke Unit (HASU) alongside a neurosurgery unit; for this reason the HASU was re-located in options A and C. However, it was also recognised that it was useful to locate these units in areas where there was most need in the population.

(ii)    A decision would be made about the hospital reconfiguration in early 2013 once the results of the consultation were known.

(iii)   Co-ordination was taking place across London to ensure that there were no gaps in services due to re-alignment taking place in more than one area.

(iv)  It was preferable to co-ordinate the realignment of certain services in a planned way rather than facing an unplanned closure as previously experienced at Ashford Hospital.

(v)    If one of the more expensive options were chosen then NHS  ...  view the full minutes text for item 15.

To receive a verbal update on the latest changes to local health services (to include an update on South West London and St George’s Mental Health Trust foundation trust application).

An update was provided by Dr Dagmar Zeuner, Joint Director of Public Health, and by Dominic Wright, Chief Officer designate of the governing body of Richmond Clinical Commissioning Group (CCG). The Committee was informed that:

(i)      The Richmond health team, including public health as well as CCG staff, was due to move to the Civic Centre on 15 October. The public health team would formally become council staff from April 2013. Co-location between CCG and council teams would allow for greater collaborative working between the two organisations. This was especially important given the relatively small size of Richmond CCG. The Scrutiny Committee would play an important role in examining the work of the CCG and its commissioning intentions.

(ii)    The CCG was preparing for taking on formal commissioning responsibilities in April 2013 when Richmond Primary Care Trust would cease to exist,. As part of this the CCG would be assessed by the NHS Commissioning Board on 15 November to demonstrate that it was a fit and proper organisation to take on these responsibilities. This involved meeting 119 key lines of inquiry.

(iii)   Work on the Health and Wellbeing Strategy was progressing: a draft version was expected in the autumn. The Health and Wellbeing Board continued to meet in shadow form but would become a statutory council committee in April 2013 with meetings in public...

Mark Dinwiddy (Interim Service Director Richmond and Kingston) provided the Committee with an update on behalf of South West London & St Georges Mental Health Trust. The Trust was currently carrying out a stakeholder consultation on its business plan proposals in relation to becoming a Foundation Trust. Mr Dinwiddy provided information about the work of rehabilitation services and the assertive outreach team.

The Committee discussed funding and resources available to the CCGs, NHS trusts and re-ablement services in particular. The effect on Richmond borough of the Better Services Better Value consultation and the Shaping a Healthier Future consultation were also considered.

It was RESOLVED that the updates be noted.

To provide an update on the procurement process within Adult Community Services including:

·         Adult Service Commissioning: Transition from Voluntary Sector Grants.

·         Adult Care Provision: Priority Programme

·         Personalisation

·         Home Support Services

·         Homecare Reablement

The Head of Service Development provided the Committee with an update on the five chosen areas of procurement which would be given further scrutiny, these being: Adult Service Commissioning; Adult Care Provision; Personalisation; Home Support Services and Homecare Reablement. Within this, there was scope for the Committee to examine areas such as voluntary sector grants and live well services; day centres and voluntary sector transport; and the personal support processes. A 12 month programme of work would allow the Committee to examine these issues at different stages of the procurement process. It was suggested that Members could form task groups or sub-groups to examine these issues in more detail.

The Head of Service Development also provided a general update on procurement within Adult and Community Services, including progress on the Carers Hub and the Advocacy Service. Work was also being carried out on a supported employment programme. In response to questions the Committee was informed that:

(i)      It was hoped that the Carers Hub would expand the numbers of carers receiving support and would provide better outcomes for those who already accessed services.  It was estimated that there were currently 14,000 carers within the borough, although the definition of a carer varied.

(ii)    The role of the Committee in examining Council procurement would be to examine policy development in the initial stages of procurement and to evaluate service delivery and whether outcomes were being achieved at later points.

(iii)   The Council could offer transitional funding for some voluntary sector organisations which did not receive full funding; however, it was not within the Council’s remit to control how organisations made their funding applications. It was noted that to get best value from procurement work the Committee should focus on outcomes for residents rather than the various details of application processes.

Members felt that it would be useful to scrutinise procurement at the earliest possible point in the process. Members were also concerned to monitor how residents’ needs were met by the Council, the voluntary sector and sub-contractors at a time when funding was more restricted.

It was RESOLVED:

That the update on the procurement process for the five programmes selected by the Committee for scrutiny from Adult and Community Services be noted.

To provide an update on strategic developments relating to Adult Safeguarding.

(Safeguarding Adults at Risk Partnership Board Annual Report attached as an Appendix)

The Assistant Director Community Care Services presented the fifth annual Safeguarding report. He highlighted key areas of improvement in the safeguarding service including the simplification of Council contact arrangements. The Assistant Director also provided an overview of the statistical data within the report, highlighting the large increase in referral figures. Further analysis of this data would be available next year but it was thought that the 73% increase in referrals could be linked in part to the Council’s campaign for greater awareness of safeguarding issues and the implementation of the Pan London Safeguarding Procedures in September 2011 (especially as the largest rise came in the second half of the year). A similar increase in referrals had also been witnessed across London. A further report into the information presented in the report was planned for completion by the end of the year. consider

The Committee discussed whether the contact for safeguarding could be further streamlined to one telephone number and whether it could be further advertised in care homes. The Assistant Director explained that a further integration of health and social care services was being considered in which this issue could be taken into account. Further publicity was also being explored. It was also important to highlight good services as well, via initiatives such as the Dignity in Care Award.

The Committee discussed the issue and prevalence of safeguarding concerns in individual care homes. The Assistant Director noted that a process to keep Councillors better informed of any reported problems in their wards could be investigated.

In response to concerns about police training on issues of abuse and hate crime, the Assistant Director explained that the Council was meeting with the Borough Commander to discuss widening the training programmes.

The Chairman welcomed the report as evidence of good work being carried out via Adult and Community Services.

It was RESOLVED:

That the Annual Report 2010/11 of the Safeguarding Adults at Risk Partnership Board, the Board’s achievements, and its future plans, be noted and endorsed.

To provide an update on Homelessness in response to the Housing Task Group Report on the impact of national policy changes.

[Councillor Butler was not present for this item.]

The Assistant Director Community Service Operations presented the report which detailed figures for Homelessness in the borough. It was explained that whilst an increase in new build homes had allowed for the relatively quick re-housing of many families, the overall level of homeless cases for whom the Council had a statutory duty to rehouse had risen significantly in the past year. If numbers continued to rise this represented a future financial challenge. Local authorities were expecting an announcement in the near future on the wording of the housing section of the Localism Act, and this might help reduce pressures on the budget. In addition, the number of people affected by cuts to housing benefits was expected to rise, having implications for housing services.

The Committee discussed the issues surrounding changes to housing benefit and the difficulty in finding affordable private tenancies in Richmond which could lead to residents being re-housed out of the borough. The Assistant Director explained that residents should not be moved if it meant that they would lose their employment.

In response to questions about whether housing associations were now choosing to sell housing stock in Richmond and invest in less expensive areas, it was explained that this was a decision for each housing association’s board, though disposal of property should be advertised via an asset management plan which was consulted on.

The Committee also discussed the usefulness of short term mortgage assistance programmes; and whether those who were ‘asset rich’ but ‘cash poor’ could be assisted in making better use of their spare rooms. The Assistant Director explained that although the latter idea seemed sensible, it was not always financially viable, nor was it popular with home owners. The Council did continue to offer a sponsored moves scheme for social housing tenants to help them move to smaller homes, thus freeing family sized properties.

It was RESOLVED:

That the latest position in relation to homelessness be noted.

To provide an update on performance in relation to projects and indicators for Adult Social Care and Housing for the period April to June 2012.

[Councillor Butler was not present for this item.]

The Head of Finance presented the report to the Committee and in response to questions explained that items would only be reported to the Committee for scrutiny if they had been flagged as areas of concern for two consecutive quarters. At this point no items had been of concern for more than one quarter.

It was RESOLVED:

That the positive progress in relation to delivery of key priorities for Adult Social Care and Housing be noted.

To receive a report on the quarter one (2012-13) Adult Social Care and Housing revenue and capital budgets.

(Appendices A to D also attached as part of the report)

 [Margaret Dangoor and Councillor Butler were not present for this item]

The Head of Finance presented the Quarter One Finance Update. He reported that there was a projected under spend of £850,000 for the Directorate’s budget in the current financial year and he outlined key changes to projected spending in relevant areas. In response to questions the Committee was informed that:

(i)      Though the eligibility criteria for care services had changed, this had not significantly impacted on the 2012/13 budget, as changes were not applied to existing service users. The forecast under spend of £586,000 on care services for older people and physical disabilities related to the impact of Reablement and lower number of admissions to care homes.

(ii)    The criteria for ongoing support had been amended but initial reablement services were free to recipients, including people with Moderate needs. 

It was RESOLVED:

That the latest projections / performance and activity information provided be noted.

To provide an opportunity for Scrutiny to input into budget development earlier than has previously been the case.

[Margaret Dangoor and Councillor Butler were not present for this item]

The report was presented by the Head of Finance. It was explained that by receiving the indicative 2013/14 budget at an earlier stage the Members of Scrutiny could have greater input into it. The Committee was reminded that the Council was working within a difficult financial climate and there were necessary budget restrictions due to reductions in public sector spending. 

In response to questions on the projected budget under spend, the Head of Finance advised the Committee that there was a forecast over spend on the Housing Temporary Accommodation budget in the current year and under spending on the Adult Social Care budget. This would be taken into account when setting the budget for 2013/14.

Committee Members discussed whether the current year’s budget under spends should necessitate a re-evaluation of the changes made to Adult Social Care services, or whether it was sufficient to re-align the budget. It was also debated whether spending on homelessness could be better predicted and provided for when setting the budget. The Committee was advised that there were often many variables which made budget planning difficult, including the delayed implementation of the Localism Act which would in future allow councils freedom to discharge homelessness duty in the private sector. It was still relatively early in the financial year to make accurate forecasts about the housing budget and there were a number of risks.

It was RESOLVED:

1. That the current developments/changes being planned for the 2013/14 budget be noted.

2. That Committee Members be given further opportunity at a future meeting to discuss the 2013/14 budget, in particular in relation to the use of projected under spends and the costs of care services.

To receive a report giving details of the proposed work programme for the Health, Housing and Adult Services Overview and Scrutiny Committee.

[Margaret Dangoor and Councillor Butler were not present for this item]

It was RESOLVED:

That the following issues be added to the work programme, subject to confirmation at a meeting of the Chairman and Vice Chairman:

1. Update on the progress of Healthwatch

2. Presentation by local Housing Associations

3. Update or Briefing on CHRE issues.